Surgery For Stenosis Research Articles

History of Surgery for Mitral Stenosis: John Mayow to Charles Bailey

Mitral stenosis was first described in 1674 by Englishman John Mayow, but surgical intervention for mitral stenosis was proposed over 2 centuries later in 1898. Mitral valve surgery was undertaken in the 1920s with varying success; after 2 decades of staggered progress, mitral valvuloplasty and commissurotomy would be rediscovered by Americans Horace Smithy, Charles Bailey, and Dwight Harken. The evolution of open surgery for mitral stenosis suggests the troubled triumph of humanity over disease while also underlining surgeons' inability to successfully disseminate their pioneering ideas to a community critical of innovation.

Peri-operative changes in diastolic function and outcomes in congenital aortic valve surgery.

BackgroundThe ratio of early diastolic mitral inflow velocity (E) to early diastolic mitral annular tissue velocity (e’), or E/e’, is an echocardiographic measure of left ventricular filling pressure. Peri‐operative changes in E/e’ and association with outcomes have been demonstrated in adults undergoing surgery for aortic stenosis (AS). We sought to explore changes in E/e’ and other diastolic indices in the setting of congenital AS surgery and to assess for association with post‐operative outcomes among children and young adults.MethodsA retrospective, single‐center study was performed among patients 6 months to 30 years of age who underwent congenital AS surgery from 2006 to 2018. Tissue Doppler indices were collected from pre‐ and post‐operative echocardiograms. Post‐operative outcomes were reviewed.ResultsSixty‐six subjects with subvalvar (45%), valvar (47%), and supravalvar (8%) AS underwent surgery at a median age of 9.5 years (IQR: 4.0–14.8). Pre‐operatively, the lateral E/e’ ratio was 8.6 (6.7–11.0); 33% had E/e’≥10. Post‐operatively, the lateral e’ decreased to 9.9 cm/s (8.0–11.4), the E/e’ ratio increased to 10.4 (8.3–13.1); and 53% had E/e’≥10 (p‐values < 0.0001, 0.0072, and < 0.001, respectively). Pre‐operative lateral e’ correlated modestly with duration of intubation (ρ = −0.24, p‐value 0.048) and post‐operative lateral e’ correlated modestly with duration of intubation and length of hospital stay (ρ = −0.28 and −0.26, p‐values = 0.02 and 0.04, respectively).ConclusionsChildren and young adults who underwent congenital AS surgery had echocardiographic evidence of diastolic dysfunction pre‐operatively that worsened post‐operatively. Lateral e’ may be a sensitive indicator of impaired ventricular relaxation in these patients and may impact duration of intubation and hospital stay.

Gastroschisis: Impact of Bedside Closure on Ventilator-Associated Outcomes.

In our practice, preformed silos are routine rather than reserved for difficult cases. We aimed to identify whether silo and bedside closure can minimize: general anesthetic (GA) exposure, need for intubation and ventilation, or days intubated for neonates with simple gastroschisis (SG). After approval, patients were identified via the neonatal discharge log (April 2010 to April 2019). Data were collected by case-note review and analyzed with respect to GA, ventilation, and core outcomes. Of 104 patients (50 female, mean birth weight 2.43 kg, mean gestational age 36 + 2 weeks), 85 were SG and 19 complex. Silo application was initial management in 70 SG, 57 completed successful bedside closure (by day 4 of life-median). Fifteen SG had initial operative closure.Of the 70 SG managed with silo, 46 (66%) had no GA as neonates. Twelve required GA for line insertion. Thirteen patients with initial silo had closure in theater (7 opportunistic at time of GA for line). Nine required intubation and ventilation out-with the operating theater during neonatal management. Seven had already been intubated at delivery; 3 because of meconium aspiration.One-hundred percent of those treated with operative closure had GA, 1 patient subsequently required surgery for subglottic stenosis. Time to full feeds did not differ between groups. Silo and bedside closure allow the majority of SG neonates to avoid GA or intubation in the neonatal period, without increased risk of complication. However, it is important that the nursing expertise required to manage these patients safely is not underestimated.

Complications of degenerative lumbar spondylolisthesis and stenosis surgery in patients over 80s: comparative study with over 60s and 70s.Experience with 678 cases

Complications of degenerative lumbar spondylolisthesis and stenosis surgery in patients over 80s: comparative study with over 60s and 70s.Experience with 678 cases

Analysis of injury and pain scores during fusion surgery for multisegmental lumbar spinal stenosis in elderly patients

Lumbar stenosis has become a common disease. Controversies exist regarding fusion surgery. The patients were divided into groups per the method of fusion received: the posterolateral fusion group (group P) and the intervertebral fusion group (group I). The patients were further divided into groups based on the number of fusion segments: the 2-segment group (P2 and I2), the 3-segment group (P3 and I3), and the 4-segment group (P4 and I4). The operative time, intraoperative blood loss, blood transfusion volume, and postoperative drainage volume were summarized. In particular, wound healing appearance and management were observed. The operation time and blood transfusion volume of the P2 and P3 groups were significantly less than those of the I2 and I3 groups (p < 0.05). The postoperative drainage volume of group I4 was less than that of group P4 (p < 0.05). Postoperative numeric rating scale (NRS) scores of P2 and P3 groups were lower than those of I2 and I3 groups (p < 0.05), while the NRS scores of P4 group were higher than those of I4 group (p < 0.05). Posterolateral and intervertebral fusion techniques can be used in the surgical treatment of elderly patients with lumbar spinal stenosis. The posterolateral fusion method should be used when three or fewer segments require surgery. The intervertebral fusion method should be used when four segments require surgery.

Endoscopic decompression for lumbar spinal canal stenosis

Laminectomy and fusion were surgical options to decompress neural structures and provide more space for the spinal cord in a stenosis patient with severe leg pain and progressive neurologic signs, such as numbness and weakness. The evolution of endoscopic spinal surgery techniques has created advantages for patients who require a laminectomy. The authors present a unique technique for endoscopic access to the central and lateral recess pathology as a minimally invasive procedure, which provides a good visualization. We performed two cases of endoscopic spinal surgery for single-level and consecutive three-level lumbar spinal canal stenosis using an 8 mm outer diameter, 5.5 mm working channel, 10° angled lens spinal endoscopic system (percutaneous stenoscopic lumbar decompression, MaxMore Spine Company, Unterföhring, Germany). Optimized endoscopic drills, forceps, and Kerrison punch were used to remove bony pathology and ligamentum flavum under direct endoscopic visualization. The first case had a narrow canal space in the L4/L5 segment with severe numbness at the same dermatome and did not respond with adequate conventional treatment. The second case had three-level canal stenosis with severe back pain and leg weakness. The purpose of this paper is to describe the technique, the efficacy, and feasibility of unilateral endoscopic laminectomy and bilateral decompression via posterior approach in lumbar spinal canal stenosis. Moreover, in this article, we present the technical details on endoscopic procedures and the prevention of complications and management during operation for spinal canal stenosis.

Chapter 12 - Intraoperative neuromonitoring during surgery for lumbar stenosis

The indications for neuromonitoring during lumbar stenosis surgery are defined by the risks associated with patient positioning, the approach, decompression of neural elements, deformity correction, and instrument implantation. The routine use of EMG and SEP alone during lumbar stenosis surgery is no longer supported by the literature. Lateral approach neuromonitoring with EMG only is also suspect. Lumbar stenosis patients often present with multiple co-morbidities which put them at risk during routine pre-surgical positioning. Frequently encountered morbid obesity and/or diabetes mellitus may play a role in monitorable and preventable brachial plexopathy after "superman" positioning or femoral neuropathy from groin pressure after prone positioning, for example. Deformity correction in lumbar stenosis surgery often demands advanced implementation of multiple neuromonitoring modalities: EMG, SEP, and MEP. Because the bulbocavernosus reflex detects the function of the conus medullaris and sacral somato afferent/efferent fibers of the cauda equina, it may also be recorded. The recommendation to record pedicle screw thresholds has become more nuanced as surgeon dependence on 3D imaging, navigation, and robotics has increased. Neuromonitoring in lumbar stenosis surgery has been subject mainly to uncontrolled case series; prospective cohort trials are also needed.

Is It Possible to Get Better Results in Bone Fusion in Laminoplasty Surgery for Lumbar Stenosis? A Novel Autologous Bone Graft Insertion Technique.

To define a novel autologous bone graft insertion technique, and to evaluate its effects on bone fusion in patients with lumbar stenosis who underwent laminoplasty. Fifty-six patients and 142 vertebrae that underwent autologous bone graft insertion technique between 2009 and 2018 were analysed retrospectively. Demographic data, comorbidities, and perioperative findings of patients were recorded. The midline anteroposterior (AP) diameter was measured at the bone graft insertion levels, and fusion formation was evaluated with computed tomography (CT) and dynamic X-Ray images. Pain scores were assessed preoperatively with the visual analogue scale (VAS) for both legs and Oswestry Disability Index (ODI) for overall life quality. Scores were re-evaluated on 1 < sup > st < /sup > day, at 3 < sup > rd < /sup > , and 12 < sup > th < /sup > months, postoperatively. Degenerative spinal stenosis was present in 56 patients who underwent autologous bone graft insertion technique. It was found that the diameter of the spinal canal increased by 37% in CT measurements. In postoperative radiological followups, fusion developed in 49 (87.5%) patients. There was a statistically significant decrease in both VAS and ODI scores in the postoperative period when compared to the preoperative evaluations. Bone graft insertion technique supports posterior fusion and protects against dural injuries during revision surgery by creating a barrier over the dura. The prevention of epidural fibrosis formation reduces the symptoms of the postlaminectomy syndrome. The fact that this technique does not require fixation material. Therefore, it reduces expenditure and eliminates the risk of complications related to synthetic materials.

What Pathology Did the Spinal Injectionist Miss? Persistent Leg Pain After Multiple Epidural Steroid Injections and Spinal Stenosis Surgery: A Case Report

What Pathology Did the Spinal Injectionist Miss? Persistent Leg Pain After Multiple Epidural Steroid Injections and Spinal Stenosis Surgery: A Case Report

Mental status plays an important role in outcome of spinal stenosis surgery

Mental status plays an important role in outcome of spinal stenosis surgery

Observation on the Efficacy of Preemptive Analgesia with Tramadol Injection after Single-Segment Lumbar Spinal Stenosis Surgery

To investigate the efficacy of preemptive analgesia with tramadol injection after single-segment lumbar spinal stenosis surgery is the objective of the study. A total of 120 patients after lumbar spinal stenosis surgery were selected by the random sampling method as the study subjects. Patients were randomly divided into a moderate pain group (control group, n=60) and a preemptive analgesia group (observation group, n=60) according to whether tramadol preemptive analgesia was used. The visual analogue scale score of the two groups were compared at 30 min, 4 h, 8 h, 16 h, 24 h and 48 h after treatment, the number of intramuscular tramadol injections and the total dosage of tramadol administration from the end of surgery to discharge, as well as adverse reactions after treatment. The visual analogue scale score at 30 min, 4 h, 8 h, 16 h and 24 h after surgery of the observation group were significantly lower than the control group (p<0.05). There was no significant difference between the two groups in the visual analogue scale score at 48 h after surgery (p>0.05).The number of intramuscular tramadol injections and the total dosage of tramadol administration from the end of surgery to discharge of the observation group were significantly lower than the control group (p<0.05). The incidence of adverse reactions in the observation group was lower than the control group, but the difference was not statistically significant (p>0.05). Tramadol preemptive analgesia after lumbar spinal stenosis surgery could effectively control pain, reduce the use frequency of postoperative painkillers, reduce the dosage of intramuscular tramadol after surgery and had fewer adverse reactions in the process of treatment to some extent.

Surgical outcomes of the thoracic ossification of ligamentum flavum: A high incidence of combined spinal stenosis

The term “tandem spinal stenosis (TSS)” has been used to describe combined cervical and lumbar canal stenosis. We identified in our large series of cases that approximately 58% of cases with cervical canal stenosis were considered to be TSS, and 15% needed surgery for concurrent lumbar spinal canal stenosis (LCS)

Postoperative Inhaled Steroids Following Glottic Airway Surgery Reduces Granulation Tissue Formation.

Transoral laser surgery for glottic stenosis (transverse cordotomy and anteromedial arytenoidectomy (TCAMA)) is often complicated by granulation tissue (GT) formation. GT can cause dyspnea and may require surgical removal to alleviate airway obstruction. Inhaled corticosteroids (ICS) have been shown to reduce benign vocal fold granulomas, however its use to prevent GT formation has not been described. We aimed to analyze the effect of immediate postoperative ICS on GT formation in patients undergoing transoral laser surgery for glottic stenosis. A retrospective analysis of patients that had transoral laser surgery for glottic stenosis from 2000 to 2019 was conducted. Surgical instances were grouped into those that received postoperative ICS and those that did not. Demographics, diagnosis, comorbidities, intraoperative adjuvant therapy, and perioperative medications were collected. Differences in GT formation and need for surgical removal were compared between groups. A multivariate exact logistic regression model was performed. Forty-four patients were included; 16 required 2 glottic airway surgeries (60 surgical instances). Of the 23 instances where patients received immediate postoperative ICS, 0 patients developed GT; and of the 37 instances that did not receive postoperative ICS, 15 (40.5%) developed GT (P < .0001). Eight (53.3%) of these cases returned to the OR for GT removal. ICS use was solely associated with the absence of GT formation (P = .042) in the multivariate analysis. Immediate postoperative use of ICS seems to be a safe and effective method to prevent granulation tissue formation and subsequent surgery in patients following transoral laser airway surgery for glottic stenosis.

New diagnostic support tool for lumbosacral foraminal stenosis using radiographs of the lumbar spine

Detection of lumbar foraminal stenosis (LFS) is difficult using common diagnostic methods, resulting in poor outcomes after lumbar spine surgery. This study aimed to develop a new support tool to detect lumbosacral foraminal stenosis. At our hospital, the following parameters were examined on standing radiographs of the lumbar spine in 100 patients who underwent surgery for lumbar spinal canal and/or foraminal stenosis: 1) presence or absence of the inclination of L5 toward the symptomatic side, 2) distance between the pedicle of L5 and S1, 3) width of the transverse process of L5, 4) distance between the transverse process of L5 and the sacral ala, 5) length of the lateral osteophyte of L5, 6) lumbosacral angle, 7) disc height of L5-S1, and 8) presence or absence of spondylolisthesis of L5. Logistic regression analysis, using cut-off values calculated by receiver operating characteristic (ROC) curve analysis, indicated that the presence of inclination in L5, length of the lateral osteophyte (≥4 mm), distance between the transverse process of L5 and the sacral ala (≤9 mm), and disc height of L5-S1 (≤5 mm) were significantly related to LFS at L5-S1 with odds ratios of 29.07, 38.83, 5.04, and 27.84, respectively. The p-value of the support tool, consisting of the odds ratios above, was 0.724 as per the Hosmer-Lemeshow analysis. ROC analysis demonstrated a cut-off value of 62 for this scoring system with 98% sensitivity and 80% specificity. Hence, we propose that this support tool could be reliably used in clinical practice.

Letter to the Editor Regarding “Biportal Endoscopic Spinal Surgery versus Microscopic Decompression for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis”

Letter to the Editor Regarding “Biportal Endoscopic Spinal Surgery versus Microscopic Decompression for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis”

Mid-term results of surgical aortic valve replacement for aortic stenosis at 108 Military Central Hospital

Objective: To study on medium-term results after aortic valve replacement surgery for aortic stenosis (AS) at 108 Military Central Hospital. Subject and method: 67 patients with AS received aortic artificial valves replacement. The results collected at the time of 3, 6, 12, 24, 36 and 48 months include: NYHA class, echocardiography (LVEDd, LVEDs, AVA, mean PG), Sokolow-Lyon, PPM and complications. Evaluation is based on the criteria of the Vietnam National Heart Association and the Guidelines of the ACC/AHA. Result: NYHA 1 was increased (76.1%) and NYHA 2 - 3 was 23.9% with p&lt;0.05 in 6 months and an increasing trend at later times (p&gt;0.05). Sokolow-Lyon index &lt; 35mm after surgery &gt; 90%, mid-term echocardiography AVA about 1.6cm², LVEF &gt; 60%, mean PG &lt; 20mmHg, LVEDd and LVEDs within normal limits. Hemorrhagic complications, stuck aortic valve (≤ 3.8%), fuite paraprosthetiques did not appear after 6 months. Conclusion: The medium-term outcome after aortic valve replacement for aortic stenosis has good clinical and subclinical improvement and the rate of medium-term complications is low.

Hydrogen Sulphide Release via the Angiotensin Converting Enzyme Inhibitor Zofenopril Prevents Intimal Hyperplasia in Human Vein Segments and in a Mouse Model of Carotid Artery Stenosis

Hypertension is a major risk factor for intimal hyperplasia (IH) and re-stenosis following vascular and endovascular interventions. Preclinical studies suggest that hydrogen sulphide (H2S), an endogenous gasotransmitter, limits re-stenosis. While there is no clinically available pure H2S releasing compound, the sulfhydryl containing angiotensin converting enzyme inhibitor zofenopril is a source of H2S. Here, it was hypothesised that zofenopril, due to H2S release, would be superior to other non-sulfhydryl containing angiotensin converting enzyme inhibitors (ACEi) in reducing intimal hyperplasia. Spontaneously hypertensive male Cx40 deleted mice (Cx40-/-) or wild type (WT) littermates were randomly treated with enalapril 20 mg or zofenopril 30 mg. Discarded human vein segments and primary human smooth muscle cells (SMCs) were treated with the active compound enalaprilat or zofenoprilat. IH was evaluated in mice 28 days after focal carotid artery stenosis surgery and in human vein segments cultured for seven days exvivo. Human primary smooth muscle cell (SMC) proliferation and migration were studied invitro. Compared with control animals (intima/media thickness 2.3 ± 0.33 μm), enalapril reduced IH in Cx40-/- hypertensive mice by 30% (1.7 ± 0.35 μm; p= .037), while zofenopril abrogated IH (0.4 ± 0.16 μm; p < .002 vs. control and p > .99 vs. sham operated Cx40-/- mice). In WT normotensive mice, enalapril had no effect (0.9665 ± 0.2 μm in control vs. 1.140 ± 0.27 μm; p > .99), while zofenopril also abrogated IH (0.1623 ± 0.07 μm; p < .008 vs. control and p > .99 vs. sham operated WT mice). Zofenoprilat, but not enalaprilat, also prevented IH in human vein segments exvivo. The effect of zofenopril on carotid and SMCs correlated with reduced SMC proliferation and migration. Zofenoprilat inhibited the mitogen activated protein kinase and mammalian target of rapamycin pathways in SMCs and human vein segments. Zofenopril provides extra beneficial effects compared with non-sulfhydryl ACEi in reducing SMC proliferation and re-stenosis, even in normotensive animals. These findings may hold broad clinical implications for patients suffering from vascular occlusive diseases and hypertension.

Waiting for lumbar spinal stenosis surgery: suffering and a possibility to discover coping abilities.

The objective of this study was to describe aspects of suffering related to being a person with LSS and how suffering is managed before LSS surgery. A Swedish county hospital. Interviews with 18 consecutive patients on the waiting list for LSS surgery. The themes that emerged from content analysis were further interpreted using Antonovsky salutogenic model as a sensitizing concept. The suffering from LSS before surgery included the main theme of experiencing an impaired physical and social life and struggling to be believed and taken seriously. This had coping strategies to manage symptoms before surgery: a good physician-patient relationship alleviates the burden of long waiting times; ways to manage pain and disability; ambiguous expectations and hope for recovery, and; ways to handle concerns before surgery). Being a person with LSS includes suffering and a possibility to discover coping abilities or having support structures for doing so. Our study emphasizes the importance of a supportive dialogue, where physicians and patients make the suffering from LSS and care before LSS surgery more comprehensible and manageable.

Efficacy and Complications of Unilateral Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis: A Meta-Analysis and Systematic Review

As an emerging minimally invasive endoscopic technique, unilateral biportal endoscopic spinal surgery (UBESS) has the advantages of flexibility, a wide and clear field of view, and less soft tissue damage. However, the clinical evidence is insufficient and controversy exists regarding UBESS for the treatment of lumbar spinal stenosis (LSS). In the present meta-analysis, we investigated the clinical efficacy and complications of UBESS for the treatment of LSS. The PubMed, Embase, Web of Science, and Cochrane Library databases were searched through to June 1, 2021 to identify all reported studies on UBESS for LSS. Only English-language studies with original reported data from ≥30 cases were considered for inclusion. The patient demographics, operative time, hospital stay, complications, visual analog scale (VAS) score, Oswestry disability index, and Macnab criteria were extracted. Quality assessment was performed using the Cochrane collaboration tool for randomized controlled trials and the Newcastle-Ottawa scale for retrospective studies. A meta-analysis was performed using a random or fixed effect model according to the heterogeneity. Thirteen studies with 586 patients and 607 operation levels were included. The mean single-level operative time, hospital stay, and follow-up duration were 61.10 minutes, 2.32 days, and 14.7 months, respectively. At the final follow-up visit, the mean VAS score for leg pain had decreased from 7.23 preoperatively to 1.83 postoperatively, the mean VAS score for back pain had decreased from 6.30 to 1.95, and the mean Oswestry disability index had significantly improved from 56.99 to 17.83. The average satisfied outcome (excellent or good using the Macnab criteria) was 86%. The overall complication rate was 5%, and the most common complication was a dural tear, with an incidence of 2%, followed by epidural hematoma with an incidence of 1%. The remaining complications were nerve root injury, inadequate decompression, and postoperative headache. From the available clinical results and experience from reported studies, UBESS for LSS is a feasible and effective approach and a worthwhile choice for clinicians. However, the complications associated with the procedure should also be seriously considered.

Comparison between microendoscopic laminectomy and open posterior decompression surgery for single-level lumbar spinal stenosis: a multicenter retrospective cohort study

BackgroundMicroendoscopic laminectomy (MEL), in which a 16-mm tubular retractor with an internal scope is used, has shown excellent surgical results for patients with lumbar spinal canal stenosis. However, no reports have directly compared MEL with open laminectomy. This study aimed to elucidate patient-reported outcomes (PROs) and perioperative complications in patients undergoing MEL versus open laminectomy.MethodsThis is a multicenter retrospective cohort study of prospectively registered patients who underwent lumbar spinal surgery at one of the six high-volume spine centers between April 2017 and September 2018. A total of 258 patients who underwent single posterior lumbar decompression at L4/L5 were enrolled in the study. With regard to demographic data, we prospectively used chart sheets to evaluate the diagnosis, operative procedure, operation time, estimated blood loss, and complications. The follow-up period was 1-year. PROs included a numerical rating scale (NRS) for lower back pain and leg pain, the Oswestry Disability Index (ODI), EuroQol 5 Dimension (EQ-5D), and patient satisfaction with the treatment.ResultsOf the 258 patients enrolled, 252 (97%) completed the 1-year follow-up. Of the 252, 130 underwent MEL (MEL group) and 122 underwent open decompression (open group). The MEL group required a significantly shorter operating time and sustained lesser intraoperative blood loss compared with the open group. The MEL group showed shorter length of postoperative hospitalization than the open group. The overall complication rate was similar (8.2% in the MEL group versus 7.7% in the open group), and the revision rate did not significantly differ. As for PROs, both preoperative and postoperative values did not significantly differ between the two groups. However, the satisfaction rate was higher in the MEL group (74%) than in the open group (53%) (p = 0.02).ConclusionsMEL required a significantly shorter operating time and resulted in lesser intraoperative blood loss compared with laminectomy. Postoperative PROs and complication rates were not significantly different between the procedures, although MEL demonstrated a better satisfaction rate.